How has Covid-19 affected the treatment of osteoporosis?

February 09, 2021

A global survey of healthcare providers by the International Osteoporosis Foundation (IOF), the National Osteoporosis Foundation (NOF) and the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) has revealed unprecedented effects of the Covid-19 pandemic on worldwide healthcare delivery for osteoporosis.

Osteoporosis is a chronic, age-related disease which is associated with life-changing fragility fractures. Approximately 740,000 people lose their lives following hip fractures every year.

The survey report is based on online questionnaires completed from April to June 2020 by 209 healthcare providers in 53 countries: 28% from Europe, 24% from North America, and 19%, 17% and 12% from the Asia-Pacific, Middle East and Latin America, respectively. The majority of the respondents (85%) were physicians, mainly representing the specialties of rheumatology (40%), endocrinology (22%), orthopaedics (15%) and internal medicine (11%).

The report provides an insight into how healthcare delivery for osteoporosis has been affected by the pandemic:IOF President Professor Cyrus Cooper, corresponding author, noted:

"The survey indicates that the identification and management of osteoporosis in patients has been profoundly affected by the pandemic, by delays in obtaining a DXA scan or in providing medication. There is a concern that the traditional gold standard assessment and management of osteoporosis patients was not performed in the majority of cases during the pandemic, leaving many patients without assessment and treatment."

Professor Susan L. Greenspan, President of NOF and senior author, stated:

"There appears to be a substantial impact on reimbursement, which may have implications for the ability to sustain and offer various osteoporosis clinical services and tests such as DXA. In the USA, despite Medicare allowing greater flexibility for home administration of injectable medication, some 39% of survey respondents were either not sure about the new arrangement or would not consider using this option. This could potentially lead to a reduction in resources, and corresponding decrease in the assessment and treatment of patients with osteoporosis and related fracture."

On a positive note almost one in three healthcare providers performed telephone consultations and one in five performed video consultations. Telemedicine has potential benefits for patients and can result in savings and efficiencies for healthcare systems. In some countries, temporary adjustments made to telemedicine reimbursement rates during the pandemic are being evaluated for implications and opportunities in the future when societies return to the new 'normal'.
Further reading

  • Fuggle, N.R., Singer, A., Gill, C. et al. How has COVID-19 affected the treatment of osteoporosis? An IOF-NOF-ESCEO global survey. Osteoporos Int (2021).
  • McCloskey, E.V., Harvey, N.C., Johansson, H. et al. Global impact of COVID-19 on non-communicable disease management: descriptive analysis of access to FRAX fracture risk online tool for prevention of osteoporotic fractures. Osteoporos Int (2020).
  • Clynes, M.A., Westbury, L.D., Dennison, E.M. et al. Bone densitometry worldwide: a global survey by the ISCD and IOF. Osteoporos Int (2020).
  • Covid-19: Updates and Resources (NOF-USA)
  • Covid-19: Simplified procedures for Fracture Liaison Services

    About the International Osteoporosis Foundation:

    The International Osteoporosis Foundation (IOF) is the world's largest nongovernmental organization dedicated to the prevention, diagnosis and treatment of osteoporosis and related musculoskeletal diseases. IOF members, including committees of scientific researchers as well as 266 patient, medical and research societies, work together to make fracture prevention and healthy mobility a worldwide health care priority. @iofbonehealth

    About the National Osteoporosis Foundation:

    Established in 1984, the National Osteoporosis Foundation is the nation's leading health organization dedicated to preventing osteoporosis and broken bones, promoting strong bones for life and reducing human suffering through programs of awareness, education, advocacy and research. For more information on the National Osteoporosis Foundation, visit

    International Osteoporosis Foundation

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